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R-45230 0 0 OFFICE COPY i PERMIT R_ 4 5 2 3 APPLICATION FOR CITY of CUPERTINO. NUMBER INSPECTION CNISION PERMIT EXPIRATION REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED .( WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION, BUILDING ADDRESS /^^/ J(�L I (/Q��� (�/� oa "" ' �/�// 1 RESIDENTIAL! \—COMMERCIAL OTHER OWNERS^ IYt/ HAZARDOUS FIRE AREA YES ❑ If I understand that a Class A NAME 1 1 `� �� ` yes s root assembly is required. NO t Intlial I.C.B.O. q Q� - EXISTING ROOFCOVERING ADDRESSIS'�/� "", NUMBER OF EXISTING COVERINGS ^� 1 ZSS _ S PHONE 1� ` CONTRACTOR'S^ per, TO BE REMOVED TO BE RETAINED NAMEQ_�Q ICrJ\ 1 TYPE OF ROOF COVERING EXISTING ADDRESS�'"l� CITYaZIP- `l J Q� =t1 �� PHONE >2 W BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ LICENSE NUMBER LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section WOOD SHAKES 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect' WOOD SHINGLES E]License Class Lic, Number�� c�i�^ OTHER (SPECIFY) ❑ Date Contracwr C)S �r�M,f\ NER-BUILDER�LA AR TION I J PROPOSED 0441, I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, altar, Improve, demolish, or repair any structure, prior to its Issuance, also requires the BUILT-UP ROOF s6 a-,, he Is licensed ❑ applicant for such permit to file a signed statement that pursuant to the provisions of to Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the 6 .� l Business and Professions Code) or that he is exempt therefrom and the basis for the alleged ASPHALT SHINGLES 6+) ❑> exemption, Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to of not more than five hundred colors ($500).): a civil penalty WOOD SHAKES er the structure i not I tended employeeswithwages as (Sec.their Bole compensation, will do ❑ I, k, and the work, entl the structure es not rm y em or eeeretl for eels (Sac. 704q Business end, Ifl d- alone Code: The Contractor's License Lew does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that WOOD SHINGLES W such Improvements Improvements ere not Intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the Dwner-builder will have the burden of proving that he dict OTHER (SPECIFY) not build or Improve for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not PROVIDE I.C.B.O. REPORT NO. apply to an owner of property who builds or improves thereon, and who contracts for such projects ' with a contractors) licensed pursuant to the Contractor's License Law. PROVIDE MFGR. INSTALLATION SPECS. ❑ I em exempt under Sec. ,B S P. C. for this reason Owner Date APPLICATION DATE VALUATION PE MIT F E WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury ono of the following declaration: ❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compensation, as provided for by Section 3700 of the Labor Catle, for the performance of the work for which thispermit isvean. - ;BBuildi g lsmlc❑ I have and will maintain Worker's Compenaetlon Insurance, as requlratl by Section 3]00 of ll V l 1lthe Labor Code, for to performance of thew k fpr which this permit is Issued. My Workersotal 'Compensation Insure ce carrla ntl Policy nu er are: .� rC� _ll JJ Cerrier Policy o. r` PERMIT AUTHORIZATION DATE CE IFICATE OF EXE TION FROM WORKERS' A) COMPENSATION INSURANCE if of / N.C{] (This section need not be completed If the permit Is for one hundred dollars (S100) or less.) I certify that In the performance of the work for which this permit Is Iseued(I shall not employ AI ' " fa hal e l spatted prior o a y r o g m eri being any person in any manner so as to become subject to the Workers' Co -1 an io ws m Cali- fornla. ' .� v � �App111?AA - ' installed. If a roof is installs wi out irst obtaining an inspection, I agree to remove all new materials for inspection. Date�O ` subject tothe OWorrkeres' Competnsatl nprovrislonla oertfflcaqe of theLaborr Codemyyooumusufo nwiith cc ly Applicant understands and will comply with all non point with such provisions or this permit shagbe deemed revoked. 44 source regulations. I certify that I have react this application and state that the above Information is correct.I agree to comply with all city and county ordinances and state laws relating to building nnstructlon, and hereby authorize representatives of this city to anter upon the above=inemlcned property for Im All roof coverings to be ass "C" or better �� lD spectlon purposes. f/ v n (We) agree to save, Indemnify and keep harmless the City of,Cupertlno against liabilities,)( ,('� - Jul judgments, costs and expenses which may In any way accrue against said City In consequence SIGNATURE O APPL CANT DATE of the granting of this permit. ('O PRE -INSPECTION: PLOD: IN -PROGRESS: INSP. DATE INS DATE - INSP.-DATE TEAR OFF INSPECTION: B TTENS: FINAL: , INSP. DATE INS .-DATE INSP, DATE NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICE COPY • SUBJECT: REROOFING POLICY FOR THE CITY OF CUPERTINO BUILDING DEPARTMENT PRIOR TO ISSUANCE OF PERMIT AND INSPECTION PHASE. 1. Prior to permit issuance, you must agree to comply with U.B.C. standards and manufacturers spec's on reroofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the reroofing is completed. 3. All types of roof shall be inspected prior to any roof being installed. 4. In order to receive a final, you must complete steps 1, 2, and 3. I,) Preinspection or tear off approval. 2.) In progress inspection approval. 3.) Final inspection approval. a.) Operable smoke detector verification • b.) Spark arrestor installation Is 5. If plywood is installed, a plywood nail inspection is required. 6. If any roof is applied without first obtaining an inspection, you will be required to remove all new material down to the sheathing and a building inspector will inspect all sheathing at that time. WE UNDERSTAND THE ABOVE POLICY ON REROOFING AND WILL COMPLY WITH THE POLICY � t ' ,` HOMEME OWNERS NA: Rs V u� t ADDRESS: REROOFING COMPANY NAME: APPLICANT'S SIGNATURE: CITY OF CUPERTINO BUILDING DEPARTMENT Reroof/winword